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Congenital cystic lesions of the lungs: The perils of misdiagnosis - A single-center experience.

Raman VS, Agarwala S, Bhatnagar V, Panda SS, Gupta AK - Lung India (2015 Mar-Apr)

Bottom Line: Of these, 20% had received a course of prior antitubercular therapy and 30% had an intercostal drain inserted prior to referral to our center.Postoperative morbidity in the form of bronchopleural fistula, pneumothorax, and non-expansion of the residual lung was noted in 10% of the patients.Prior to referral to a pediatric surgical center a large number of patients received antitubercular drugs and an intercostal drain insertion, due to incorrect diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: A majority of cystic lesions in the western world are detected antenatally, whereas, the diagnosis in our setup occurs once the child becomes symptomatic. Surgical management is primarily dictated by the presence of symptoms, recurrent infection, and rarely by the potential risk of malignant transformation.

Materials and methods: A retrospective analysis was carried out on all consecutive patients with cystic lung lesions managed at our center from January 2000 through June 2011 for antenatal diagnosis, presentation, diagnostic modalities, treatment, and complications.

Results: Forty cystic lung lesions were identified. Only 8% were antenatally detected. Out of 40, the final diagnosis was congenital cystic adenomatoid malformation in 19, congenital lobar emphysema in 11, and bronchogenic cysts and pulmonary sequestration in five each. Of these, 20% had received a course of prior antitubercular therapy and 30% had an intercostal drain inserted prior to referral to our center. Postoperative morbidity in the form of bronchopleural fistula, pneumothorax, and non-expansion of the residual lung was noted in 10% of the patients.

Conclusion: Antenatal diagnosis of these lesions is still uncommon in third world countries. Prior to referral to a pediatric surgical center a large number of patients received antitubercular drugs and an intercostal drain insertion, due to incorrect diagnosis.

No MeSH data available.


Related in: MedlinePlus

Lobar distribution of the cystic lesions (including four patients with multilobar involvement)
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Figure 1: Lobar distribution of the cystic lesions (including four patients with multilobar involvement)

Mentions: All patients were investigated with a standard chest X-ray (CXR) and computed tomography (CT) scan. The CXR was accurate in identifying a cystic lesion in 18 patients (45%) compared with a CT scan, which picked up the lesion in all 40 patients (100%). Nineteen (47.5%) children became symptomatic in the neonatal period, 13 (32.5%) between one month and one year, seven (18%) between one and five years, and one (2%) beyond five years of age. Respiratory distress was the most common presenting symptom in children less than one year of age, while respiratory infections were common in children presenting after one year of age. Eight (20%) children had received a full course of prior antitubercular therapy due to misdiagnosis. Twelve (30%) children had an intercostal drain (ICD) inserted, prior to referral to our center, due to a mistaken diagnosis of pneumothorax. All patients underwent open surgical resection by posterolateral thoracotomy, out of which eight were performed in the neonatal period. The average duration of the postoperative ICD drainage was 3.5 days (1-11 days) and the average duration of hospital stay was five days (4-11 days). The final histological diagnosis was CCAM in 19 (48%), CLE in 11 (28%), bronchogenic cyst in five (12%), and pulmonary sequestration in five (12%). There were no hybrid lesions. Out of 40 patients, 21 (52%) had lesions on the right side and 19 (48%) on the left side, and four patients had multilobar involvement. Two CCAMs involved all the lobes, one right CCAM involved both upper and middle lobes, and one right CLE involved both middle and lower lobes [Figure 1]. Thirty patients underwent lobectomies, two underwent pneumonectomies, and eight underwent excisions for a bronchogenic cyst and for extralobar pulmonary sequestrations [Table 1]. Seven patients required postoperative ventilation with a median duration of 48 hours.


Congenital cystic lesions of the lungs: The perils of misdiagnosis - A single-center experience.

Raman VS, Agarwala S, Bhatnagar V, Panda SS, Gupta AK - Lung India (2015 Mar-Apr)

Lobar distribution of the cystic lesions (including four patients with multilobar involvement)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372863&req=5

Figure 1: Lobar distribution of the cystic lesions (including four patients with multilobar involvement)
Mentions: All patients were investigated with a standard chest X-ray (CXR) and computed tomography (CT) scan. The CXR was accurate in identifying a cystic lesion in 18 patients (45%) compared with a CT scan, which picked up the lesion in all 40 patients (100%). Nineteen (47.5%) children became symptomatic in the neonatal period, 13 (32.5%) between one month and one year, seven (18%) between one and five years, and one (2%) beyond five years of age. Respiratory distress was the most common presenting symptom in children less than one year of age, while respiratory infections were common in children presenting after one year of age. Eight (20%) children had received a full course of prior antitubercular therapy due to misdiagnosis. Twelve (30%) children had an intercostal drain (ICD) inserted, prior to referral to our center, due to a mistaken diagnosis of pneumothorax. All patients underwent open surgical resection by posterolateral thoracotomy, out of which eight were performed in the neonatal period. The average duration of the postoperative ICD drainage was 3.5 days (1-11 days) and the average duration of hospital stay was five days (4-11 days). The final histological diagnosis was CCAM in 19 (48%), CLE in 11 (28%), bronchogenic cyst in five (12%), and pulmonary sequestration in five (12%). There were no hybrid lesions. Out of 40 patients, 21 (52%) had lesions on the right side and 19 (48%) on the left side, and four patients had multilobar involvement. Two CCAMs involved all the lobes, one right CCAM involved both upper and middle lobes, and one right CLE involved both middle and lower lobes [Figure 1]. Thirty patients underwent lobectomies, two underwent pneumonectomies, and eight underwent excisions for a bronchogenic cyst and for extralobar pulmonary sequestrations [Table 1]. Seven patients required postoperative ventilation with a median duration of 48 hours.

Bottom Line: Of these, 20% had received a course of prior antitubercular therapy and 30% had an intercostal drain inserted prior to referral to our center.Postoperative morbidity in the form of bronchopleural fistula, pneumothorax, and non-expansion of the residual lung was noted in 10% of the patients.Prior to referral to a pediatric surgical center a large number of patients received antitubercular drugs and an intercostal drain insertion, due to incorrect diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: A majority of cystic lesions in the western world are detected antenatally, whereas, the diagnosis in our setup occurs once the child becomes symptomatic. Surgical management is primarily dictated by the presence of symptoms, recurrent infection, and rarely by the potential risk of malignant transformation.

Materials and methods: A retrospective analysis was carried out on all consecutive patients with cystic lung lesions managed at our center from January 2000 through June 2011 for antenatal diagnosis, presentation, diagnostic modalities, treatment, and complications.

Results: Forty cystic lung lesions were identified. Only 8% were antenatally detected. Out of 40, the final diagnosis was congenital cystic adenomatoid malformation in 19, congenital lobar emphysema in 11, and bronchogenic cysts and pulmonary sequestration in five each. Of these, 20% had received a course of prior antitubercular therapy and 30% had an intercostal drain inserted prior to referral to our center. Postoperative morbidity in the form of bronchopleural fistula, pneumothorax, and non-expansion of the residual lung was noted in 10% of the patients.

Conclusion: Antenatal diagnosis of these lesions is still uncommon in third world countries. Prior to referral to a pediatric surgical center a large number of patients received antitubercular drugs and an intercostal drain insertion, due to incorrect diagnosis.

No MeSH data available.


Related in: MedlinePlus